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前交叉韧带重建术后隧道位置对预后的重要性:一项基于三维CT的研究

How Important is the Tunnel Position in Outcomes Post-ACL Reconstruction: A 3D CT-Based Study.

作者信息

Mhaskar Vikram A, Jain Yogesh, Soni Pankaj, Fiske Rajendra, Maheshwari Jitendra

机构信息

Department of Orthopaedics, Max Smart Hospital Saket, New Delhi, 110017 India.

Knee & Shoulder Clinic, F7 East Of Kailash, New Delhi, 110017 India.

出版信息

Indian J Orthop. 2021 Aug 15;56(2):312-318. doi: 10.1007/s43465-021-00485-4. eCollection 2022 Feb.

Abstract

BACKGROUND

Drilling the femoral and tibial tunnels at their anatomical locations are critical for good outcomes and involve seeing the footprints well. We intended to compare two techniques of drilling the tunnels and the patient-reported outcomes and knee stability of patients undergoing single bundle ACL reconstruction using 3D CT to evaluate if the tunnels were anatomical or not.

MATERIALS AND METHODS

Sixty single bundle ACL reconstructions were analyzed, 30 each with Technique A and B. Pre-operative and after a minimum 27 month follow-up Lysholm, IKDC, Tegner score, hop test, and Lachman test were noted. 3D CT was done to classify femoral tunnels positions as being well placed, slightly or grossly misplaced and tibial tunnels as optimal or suboptimal and compared.

RESULTS

Sixty ACL reconstructions had full follow-up with a mean follow-up of 34 months. There was no significant difference between tunnel positions between the two techniques. Well-placed femoral tunnel had better Lysholm score (62.2 ± 16.2 v/s 48.5 ± 17.2, 0.002) and IKDC score (62.5 ± 14.3 v/s 52.7 ± 15.1, 0.012).). Those who had their surgeries within 3 months of their injury had better hop test (4.4 ± 0.9 v/s 3.9 ± 1, 0.034) and IKDC scores (62.5 ± 15.8 v/s 33.2 ± 13.8, 0.026) as compared to those that had surgery done after 3 months.

CONCLUSION

Tibial tunnel positions were optimal in most cases and did not differ between the two techniques. Well-placed femoral tunnels and surgeries done within 3 months of the injury produced best results.

摘要

背景

在股骨和胫骨隧道的解剖位置进行钻孔对于取得良好的治疗效果至关重要,这需要清晰地看到骨隧道印记。我们旨在比较两种钻孔技术以及采用三维CT评估隧道位置是否符合解剖结构的单束前交叉韧带重建患者的患者报告结局和膝关节稳定性。

材料与方法

分析60例单束前交叉韧带重建病例,技术A和技术B各30例。记录术前及至少随访27个月后的Lysholm评分、国际膝关节文献委员会(IKDC)评分、Tegner评分、单腿跳测试和拉赫曼试验结果。通过三维CT将股骨隧道位置分类为位置良好、轻度或严重错位,胫骨隧道分类为最佳或次优,并进行比较。

结果

60例前交叉韧带重建患者均获得完整随访,平均随访时间为34个月。两种技术在隧道位置方面无显著差异。位置良好的股骨隧道Lysholm评分更高(62.2±16.2对48.5±17.2,P=0.002),IKDC评分也更高(62.5±14.3对52.7±15.1,P=0.012)。与受伤后3个月后进行手术的患者相比,受伤后3个月内进行手术的患者单腿跳测试结果更好(4.4±0.9对3.9±1,P=0.034),IKDC评分也更高(62.5±15.8对33.2±13.8,P=0.026)。

结论

大多数情况下胫骨隧道位置最佳,两种技术之间无差异。位置良好的股骨隧道以及受伤后3个月内进行的手术产生了最佳效果。

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